Are Medicare Premiums Tax Deductible: AGI Floor and IRMAA Rules

Yes, Medicare premiums are tax deductible as a medical expense. For most people, that means adding them to your other unreimbursed medical costs on Schedule A and deducting only the portion above 7.5% of your adjusted gross income — and only if your total itemized deductions beat the standard deduction. If you’re self-employed, the rules are much friendlier: you can generally deduct 100% of your Medicare premiums directly against your income, no itemizing required.

The 7.5% AGI Floor

Federal law lets you deduct unreimbursed medical expenses, including insurance premiums, but only the amount that exceeds 7.5% of your AGI.¹ You claim it on Schedule A, so you have to itemize.

Itemizing is worth it only when your total deductions clear the standard deduction. For 2026 that’s $16,100 single, $32,200 married filing jointly, and $24,150 head of household.²

The math is straightforward. AGI of $60,000 puts your floor at $4,500. If your total qualifying medical expenses for the year — premiums, copays, prescriptions, dental work, everything — add up to $6,000, you deduct $1,500. If they add up to $4,200, you deduct nothing. Medicare premiums by themselves rarely clear the floor for a single filer, so combining them with every other qualifying medical cost is how the deduction usually gets built.

Which Medicare Premiums Count

All parts of Medicare qualify as medical expenses.³

Part A. Most people pay no Part A premium because of their work history.⁴ If you buy in voluntarily, that premium — $565 per month in 2026, or $311 with at least 30 quarters of work credits — is deductible.⁵ The Medicare payroll taxes you paid while working are not deductible.

Part B. Deductible. The 2026 standard premium is $202.90 a month, roughly $2,434.80 a year before any surcharge.⁵ Whether it’s deducted from your Social Security check or paid directly makes no difference.³

Part C (Medicare Advantage). The medical insurance portion of a Medicare Advantage premium is deductible. If the plan bundles non-medical extras such as gym membership or meal delivery, only the medical portion counts, and the plan should break out the amounts.³

Part D. Stand-alone drug plan premiums and the drug portion of a Medicare Advantage plan are deductible.³ The 2026 national base beneficiary premium is $38.99 per month.⁶

Medigap. Medicare Supplement premiums are deductible under the same medical-expense rules.³ Because Medigap can run $100 to $300 or more per month, it often does the heavy lifting in getting your total above the 7.5% floor.

IRMAA Surcharges Are Deductible Too

If your income triggers an Income-Related Monthly Adjustment Amount on Part B or Part D, that surcharge is part of your premium and deductible along with the base amount.³ For 2026, IRMAA starts at $109,000 for individual filers and $218,000 for joint filers, and a high-income couple can end up with more than $18,000 in combined annual Medicare premiums, all of it deductible.⁵ If a life-changing event like retirement, divorce, or the death of a spouse dropped your income, you can ask Social Security to recalculate IRMAA using a more recent year.

The Self-Employed Route

If you have self-employment income, the deduction works differently and much better. You can deduct up to 100% of Medicare premiums for all parts as an above-the-line adjustment to income on Schedule 1, no 7.5% floor and no itemizing required.⁷ The claim runs through Form 7206.⁸

It’s available to sole proprietors with net profit on Schedule C or F, partners with net self-employment earnings on a Schedule K-1, and more-than-2% S-corporation shareholders where the corporation pays or reimburses the premiums and reports the amount as wages on the W-2.⁹ Premiums for you, your spouse, dependents, and children under 27 all qualify.

Two limits. The deduction can’t exceed net earnings from the business the plan is established under.⁷ And you can’t claim it for any month you were eligible for a subsidized health plan through any employer, including a spouse’s. Any premium that doesn’t qualify here can still go on Schedule A subject to the 7.5% floor.⁸

No Double-Dipping With HSAs and Similar Accounts

You can’t get two tax benefits for the same dollar. After age 65, you can use HSA funds tax-free to pay Medicare Part B, Part D, and Medicare Advantage premiums, but not Medigap.¹⁰ Anything paid from the HSA can’t also be deducted on Schedule A, because the tax-free withdrawal already delivered the benefit. New HSA contributions stop once you’re on Medicare, though you can keep spending the balance.

Flexible Spending Accounts generally can’t reimburse Medicare premiums. Health Reimbursement Arrangements sometimes can, depending on plan rules, and any reimbursed amount is off-limits for Schedule A. The same rule applies if a former employer pays your Medicare premiums directly or if they come out of a pension pre-tax: only what you pay with your own after-tax dollars is deductible.³

Deducting a Spouse’s Medicare Premiums

You can include Medicare premiums paid for your spouse in your medical expense total, provided you were married either when the services were received or when you paid.³ Combining both spouses’ premiums on one return is often what makes clearing the 7.5% floor realistic. A couple both paying the standard Part B premium plus a Part D plan can reach $6,000 or more in Medicare premiums alone before adding copays, prescriptions, and dental care.

1
Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, etc., Expenses
2
Internal Revenue Service. IRS Releases Tax Inflation Adjustments for Tax Year 2026, Including Amendments From the One, Big, Beautiful Bill
3
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
4
Medicare. Costs
5
CMS. 2026 Medicare Parts A and B Premiums and Deductibles
6
CMS. 2026 Medicare Part D Bid Information and Part D Premium Stabilization Demonstration Parameters
7
Office of the Law Revision Counsel. 26 USC 162 – Trade or Business Expenses
8
Internal Revenue Service. Instructions for Form 7206 (2025)
9
Internal Revenue Service. S Corporation Compensation and Medical Insurance Issues
10
Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans